# The most-missed USMLE topics in StepGenie's answer log

Snapshot generated September 5, 2026. Window March 9, 2026 to September 5, 2026. Source: StepGenie's own answer log, first attempts only.

## Which USMLE topics do students get wrong most often?

Across 166,979 Step 1 first attempts from 3,803 students in the last 180 days, the hardest topic is DNA, RNA, nucleic acid at 34.2% first-attempt accuracy, against a Step 1 average of 58.6%. On Step 2 CK the hardest is Cardiovascular drugs at 47.0%.

## What was measured

| Exam | First attempts | Students | Distinct questions | First-attempt accuracy | Topics published |
| --- | --- | --- | --- | --- | --- |
| Step 1 | 166,979 | 3,803 | 3,646 | 58.6% | 173 |
| Step 2 CK | 91,882 | 991 | 4,396 | 63.1% | 115 |

## Step 1 topics ranked by first-attempt accuracy

| # | Topic | System | First-attempt accuracy | First attempts | Students | Questions |
| --- | --- | --- | --- | --- | --- | --- |
| 1 | DNA, RNA, nucleic acid | Biochemistry (General Principles) | 34.2% | 526 | 314 | 6 |
| 2 | Metabolic enzymes | Biochemistry (General Principles) | 38.0% | 300 | 139 | 6 |
| 3 | NNT/NNH + ARR/ARI + RRR | Biostatistics & Epidemiology | 39.6% | 402 | 201 | 9 |
| 4 | DNA structure, replication, and repair | Genetics (General Principles) | 40.3% | 472 | 314 | 7 |
| 5 | Innervation of Other organ systems | Neurology | 40.5% | 380 | 148 | 7 |
| 6 | Toxic drug effects | Hematology & Oncology | 41.6% | 813 | 205 | 18 |
| 7 | Cardioembolic disease | Cardiovascular System | 43.8% | 283 | 163 | 5 |
| 8 | Mechanisms of action | Pharmacology (General Principles) | 45.0% | 160 | 87 | 5 |
| 9 | Dyslipidemias | Cardiovascular System | 47.3% | 391 | 172 | 8 |
| 10 | Cell-mediated immunity and disorders | Immunology | 48.4% | 1,136 | 418 | 29 |
| 11 | Bioenergetics and carbohydrate metabolism | Biochemistry (General Principles) | 48.8% | 862 | 342 | 14 |
| 12 | Tumors / Malignancy | Reproductive (Male) | 48.8% | 467 | 152 | 11 |
| 13 | Menstrual disorders and contraception | Reproductive (Female) | 49.1% | 450 | 156 | 11 |
| 14 | Miscellaneous | Renal, Urinary Systems & Electrolytes | 49.4% | 429 | 155 | 12 |
| 15 | Traumatic brain injuries | Neurology | 49.5% | 210 | 97 | 6 |
| 16 | Congenital and developmental anomalies | Endocrine, Diabetes & Metabolism | 50.4% | 470 | 160 | 12 |
| 17 | Normal pulmonary structure and function | Pulmonary & Critical Care | 51.1% | 1,863 | 416 | 37 |
| 18 | Normal structure and function of the cardiovascular system | Cardiovascular System | 51.2% | 2,689 | 701 | 41 |
| 19 | Platelet disorders | Hematology & Oncology | 51.5% | 969 | 533 | 12 |
| 20 | Breast tumors / malignancy | Reproductive (Female) | 51.5% | 796 | 193 | 20 |
| 21 | Study design and interpretation | Biostatistics & Epidemiology | 51.9% | 1,068 | 324 | 29 |
| 22 | Autoimmune disorders | Immunology | 52.0% | 402 | 143 | 13 |
| 23 | Tumors/Malignancy of the GI tract | Gastroenterology | 52.2% | 1,162 | 315 | 29 |
| 24 | Measures and distribution of data | Biostatistics & Epidemiology | 52.4% | 233 | 87 | 8 |
| 25 | Normal structure and function of endocrine glands | Endocrine, Diabetes & Metabolism | 52.6% | 894 | 252 | 19 |
| 26 | Substance use disorders | Psychiatry | 52.8% | 2,451 | 465 | 51 |
| 27 | General Cell function | Immunology | 53.0% | 683 | 290 | 16 |
| 28 | Bias concepts | Biostatistics & Epidemiology | 53.0% | 415 | 121 | 13 |
| 29 | Inflammation and repair | Pathology (General Principles) | 53.0% | 270 | 119 | 5 |
| 30 | Organellar function | Biochemistry (General Principles) | 53.3% | 289 | 137 | 5 |
| 31 | Hepatic disorders | Gastroenterology | 53.4% | 2,960 | 609 | 68 |
| 32 | Ischemic heart disease | Cardiovascular System | 53.4% | 1,236 | 458 | 25 |
| 33 | Normal behavior and development | Psychiatry | 53.5% | 456 | 128 | 14 |
| 34 | Anesthesia | Neurology | 53.6% | 209 | 98 | 5 |
| 35 | Collagen / Connective tissue disorders | Biochemistry (General Principles) | 53.7% | 272 | 141 | 5 |
| 36 | Autoregulation | Cardiovascular System | 53.9% | 360 | 166 | 6 |
| 37 | Bone tumors and tumor-like lesions | Musculoskeletal | 53.9% | 191 | 92 | 5 |
| 38 | Drug effects / Toxic neuropathies | Neurology | 54.3% | 3,678 | 680 | 68 |
| 39 | Muscular disorders | Musculoskeletal | 54.6% | 562 | 290 | 11 |
| 40 | Critical care medicine | Pulmonary & Critical Care | 54.9% | 557 | 279 | 10 |
| 41 | Gynecologic infections | Reproductive (Female) | 55.1% | 673 | 287 | 13 |
| 42 | Upper limb nerves | Musculoskeletal | 55.2% | 1,206 | 382 | 22 |
| 43 | Fungal infections | Infectious Diseases | 55.2% | 420 | 136 | 10 |
| 44 | Antimicrobial drugs | Infectious Diseases | 55.3% | 2,112 | 578 | 52 |
| 45 | Strokes & Stroke-related stuff | Neurology | 55.3% | 702 | 367 | 17 |
| 46 | Statistical tests | Biostatistics & Epidemiology | 55.3% | 141 | 68 | 5 |
| 47 | Congenital and developmental anomalies | Musculoskeletal | 55.4% | 249 | 103 | 8 |
| 48 | Bacterial infections | Infectious Diseases | 55.5% | 4,459 | 681 | 102 |
| 49 | Heart failure and shock | Cardiovascular System | 55.5% | 1,846 | 572 | 30 |
| 50 | Acute kidney injury | Renal, Urinary Systems & Electrolytes | 55.5% | 1,536 | 393 | 33 |
| 51 | Aortic and peripheral artery diseases | Cardiovascular System | 55.6% | 945 | 276 | 23 |
| 52 | Gastroesophageal disorders | Gastroenterology | 55.8% | 1,233 | 329 | 29 |
| 53 | Miscellaneous | Pulmonary & Critical Care | 55.8% | 858 | 188 | 22 |
| 54 | Normal structure and function of the musculoskeletal system | Musculoskeletal | 55.8% | 830 | 234 | 20 |
| 55 | Glycogen storage diseases | Biochemistry (General Principles) | 55.8% | 337 | 148 | 6 |
| 56 | Drug reactions | Dermatology | 55.9% | 1,196 | 486 | 18 |
| 57 | Cardiac arrhythmias | Cardiovascular System | 56.0% | 919 | 344 | 18 |
| 58 | Intestinal and colorectal disorders | Gastroenterology | 56.1% | 1,717 | 455 | 31 |
| 59 | Toxicology | Poisoning & Environmental Exposure | 56.2% | 361 | 96 | 15 |
| 60 | PTH, Ca, PO4, ALP, Vit D stuff | Endocrine, Diabetes & Metabolism | 56.3% | 1,422 | 406 | 32 |
| 61 | Immunologic phenomena | Dermatology | 56.3% | 462 | 133 | 15 |
| 62 | Clinical genetics | Genetics (General Principles) | 56.3% | 378 | 112 | 12 |
| 63 | Infections / infection-related conditions | Cardiovascular System | 56.4% | 1,107 | 293 | 24 |
| 64 | Metabolic bone disorders | Musculoskeletal | 56.4% | 893 | 404 | 18 |
| 65 | Cellular pathology | Pathology (General Principles) | 56.4% | 527 | 275 | 6 |
| 66 | Fluid, electrolytes, and acid-base | Renal, Urinary Systems & Electrolytes | 56.5% | 2,624 | 378 | 67 |
| 67 | Valvular heart diseases | Cardiovascular System | 56.7% | 1,731 | 489 | 33 |
| 68 | Electrolytes + electrolyte disorders | Endocrine, Diabetes & Metabolism | 56.7% | 353 | 141 | 8 |
| 69 | Syndromic conditions | Dermatology | 56.8% | 315 | 127 | 9 |
| 70 | Vasculitis conditions (Vasculitides) | Cardiovascular System | 56.9% | 378 | 186 | 7 |
| 71 | Hemolytic disorders | Hematology & Oncology | 57.0% | 1,218 | 273 | 27 |
| 72 | Autoimmune conditions | Neurology | 57.1% | 489 | 148 | 13 |
| 73 | Thyroid disorders | Endocrine, Diabetes & Metabolism | 57.4% | 2,790 | 543 | 49 |
| 74 | Diabetes mellitus | Endocrine, Diabetes & Metabolism | 57.4% | 2,134 | 538 | 42 |
| 75 | Murmurs | Cardiovascular System | 57.4% | 437 | 180 | 9 |
| 76 | Pulmonary infections | Pulmonary & Critical Care | 57.5% | 2,971 | 549 | 50 |
| 77 | Pharmacokinetics/dynamics | Pharmacology (General Principles) | 57.7% | 897 | 377 | 13 |
| 78 | Cardiovascular drugs | Cardiovascular System | 57.8% | 3,048 | 436 | 70 |
| 79 | Vitamins, cofactors, nutrients | Biochemistry (General Principles) | 57.8% | 483 | 185 | 10 |
| 80 | Incidence/Prevalence | Biostatistics & Epidemiology | 57.9% | 484 | 369 | 6 |
| 81 | Autoimmune disorders | Gastroenterology | 58.0% | 569 | 190 | 15 |
| 82 | Chronic kidney disease | Renal, Urinary Systems & Electrolytes | 58.3% | 784 | 208 | 20 |
| 83 | Nephrotic & nephritic syndromes | Renal, Urinary Systems & Electrolytes | 58.4% | 2,283 | 448 | 47 |
| 84 | Principles of oncology | Hematology & Oncology | 58.4% | 1,070 | 265 | 23 |
| 85 | Bone/joint injuries and infections | Musculoskeletal | 58.6% | 326 | 126 | 10 |
| 86 | Myopericardial diseases | Cardiovascular System | 58.7% | 596 | 197 | 15 |
| 87 | Cardiac and vascular neoplasia | Cardiovascular System | 58.8% | 291 | 145 | 7 |
| 88 | Mood disorders | Psychiatry | 58.9% | 620 | 262 | 14 |
| 89 | Miscellaneous | Endocrine, Diabetes & Metabolism | 59.1% | 587 | 218 | 12 |
| 90 | Urinary incontinence | Renal, Urinary Systems & Electrolytes | 59.2% | 665 | 383 | 5 |
| 91 | Neoplasia + tumor disorders | Dermatology | 59.4% | 939 | 225 | 29 |
| 92 | Congenital and developmental anomalies | Renal, Urinary Systems & Electrolytes | 59.4% | 387 | 132 | 9 |
| 93 | Reproductive endocrinology | Endocrine, Diabetes & Metabolism | 59.4% | 350 | 146 | 9 |
| 94 | Pancreatic disorders | Gastroenterology | 59.5% | 420 | 161 | 10 |
| 95 | Immunodeficiency syndromes | Immunology | 59.6% | 2,629 | 566 | 67 |
| 96 | Psychotic disorders | Psychiatry | 59.6% | 492 | 402 | 7 |
| 97 | Normal structure and function of the nervous system | Neurology | 59.7% | 1,729 | 438 | 40 |
| 98 | Disorders of RBCs and hemoglobin | Hematology & Oncology | 59.8% | 2,223 | 483 | 44 |
| 99 | Lung cancer | Pulmonary & Critical Care | 59.8% | 704 | 191 | 17 |
| 100 | Autoimmune processes | Renal, Urinary Systems & Electrolytes | 59.9% | 274 | 112 | 7 |
| 101 | Adrenal disorders | Endocrine, Diabetes & Metabolism | 60.0% | 1,063 | 231 | 24 |
| 102 | Normal structure and function of the female reproductive system and breast | Reproductive (Female) | 60.1% | 1,127 | 249 | 27 |
| 103 | Disorders of the eye and associated structures | Ophthalmology | 60.1% | 872 | 202 | 33 |
| 104 | Disorders of nutrition | Gastroenterology | 60.2% | 1,788 | 543 | 33 |
| 105 | Disorders of the male reproductive system | Reproductive (Male) | 60.3% | 2,706 | 724 | 53 |
| 106 | Biliary tract disorders | Gastroenterology | 60.6% | 411 | 155 | 10 |
| 107 | Graft/Tissue responses | Immunology | 60.7% | 183 | 86 | 6 |
| 108 | Miscellaneous | Gastroenterology | 60.8% | 1,000 | 413 | 13 |
| 109 | Acid/base | Pulmonary & Critical Care | 60.8% | 650 | 177 | 16 |
| 110 | Hernias / Congenital anomalies | Reproductive (Male) | 60.8% | 515 | 157 | 14 |
| 111 | Amino acids, proteins, and enzymes | Biochemistry (General Principles) | 61.0% | 1,537 | 512 | 17 |
| 112 | Inflammatory dermatoses and bullous diseases | Dermatology | 61.1% | 995 | 228 | 30 |
| 113 | Miscellaneous | Neurology | 61.1% | 509 | 167 | 12 |
| 114 | Endocrine tumors | Endocrine, Diabetes & Metabolism | 61.2% | 1,195 | 290 | 28 |
| 115 | Congenital heart disease | Cardiovascular System | 61.3% | 2,473 | 535 | 42 |
| 116 | Sensitivity/Specificity | Biostatistics & Epidemiology | 61.3% | 256 | 83 | 9 |
| 117 | Viral infections | Infectious Diseases | 61.7% | 2,868 | 486 | 68 |
| 118 | Tumors/Malignancy of the nervous system | Neurology | 61.7% | 1,064 | 406 | 22 |
| 119 | Spinal cord disorders | Neurology | 61.7% | 664 | 392 | 13 |
| 120 | Neurodegenerative disorders and dementias | Neurology | 61.9% | 2,135 | 459 | 42 |
| 121 | Obstructive lung disease | Pulmonary & Critical Care | 62.0% | 1,932 | 485 | 32 |
| 122 | Infection-related presentations | Dermatology | 62.0% | 392 | 121 | 12 |
| 123 | Genital tract tumors and tumor-like lesions | Reproductive (Female) | 62.3% | 244 | 123 | 5 |
| 124 | Normal structure and function of the kidneys and urinary system | Renal, Urinary Systems & Electrolytes | 62.4% | 1,884 | 548 | 39 |
| 125 | Miscellaneous | Infectious Diseases | 62.4% | 226 | 109 | 7 |
| 126 | Disorders of pregnancy (non-infectious) | Reproductive (Female) | 62.5% | 1,670 | 300 | 41 |
| 127 | Autoimmune-related disorders | Pulmonary & Critical Care | 62.5% | 248 | 100 | 7 |
| 128 | Innervation | Reproductive (Female) | 62.8% | 188 | 98 | 5 |
| 129 | Gynecologic tumors / malignancy | Reproductive (Female) | 62.9% | 1,716 | 441 | 28 |
| 130 | Amenorrhea/Oligomenorrhea | Reproductive (Female) | 62.9% | 580 | 250 | 13 |
| 131 | Ovarian disorders | Reproductive (Female) | 63.1% | 214 | 104 | 5 |
| 132 | Skin and soft tissue infections | Dermatology | 63.3% | 821 | 197 | 27 |
| 133 | Bone marrow disorders | Hematology & Oncology | 63.3% | 725 | 307 | 13 |
| 134 | Parasitic and helminthic infections | Infectious Diseases | 63.3% | 581 | 180 | 15 |
| 135 | Hypertension | Cardiovascular System | 63.5% | 482 | 186 | 10 |
| 136 | Miscellaneous | Immunology | 63.7% | 419 | 260 | 9 |
| 137 | Glomerular diseases | Renal, Urinary Systems & Electrolytes | 63.8% | 1,328 | 280 | 32 |
| 138 | WBC disorders | Hematology & Oncology | 64.0% | 995 | 432 | 16 |
| 139 | Genitourinary tract infections | Renal, Urinary Systems & Electrolytes | 64.1% | 771 | 315 | 16 |
| 140 | Lower limb nerves | Musculoskeletal | 64.1% | 540 | 168 | 14 |
| 141 | Cytokines and immunomediators | Immunology | 64.1% | 410 | 147 | 13 |
| 142 | Absorptive conditions | Gastroenterology | 64.3% | 476 | 185 | 12 |
| 143 | Congenital and developmental anomalies | Reproductive (Female) | 64.8% | 1,288 | 427 | 28 |
| 144 | Syndromic conditions | Genetics (General Principles) | 64.8% | 812 | 323 | 20 |
| 145 | Humoral immunity and disorders | Immunology | 64.8% | 691 | 185 | 21 |
| 146 | Disorders of peripheral nerves and muscles | Neurology | 64.8% | 386 | 142 | 9 |
| 147 | DVT/PE | Pulmonary & Critical Care | 64.8% | 355 | 158 | 7 |
| 148 | Neoplasms of the kidneys and urinary tract | Renal, Urinary Systems & Electrolytes | 64.9% | 898 | 421 | 12 |
| 149 | CNS infections | Neurology | 65.1% | 687 | 168 | 18 |
| 150 | Anxiety and trauma-related disorders | Psychiatry | 65.2% | 382 | 245 | 9 |
| 151 | Infections of the head and neck | Ear, Nose & Throat (ENT) | 65.4% | 188 | 102 | 7 |
| 152 | Cell signaling and mechanisms | Endocrine, Diabetes & Metabolism | 65.6% | 1,154 | 444 | 16 |
| 153 | Hemostasis and thrombosis | Hematology & Oncology | 65.9% | 1,145 | 372 | 22 |
| 154 | Nephrolithiasis and urinary tract obstruction | Renal, Urinary Systems & Electrolytes | 66.0% | 921 | 234 | 22 |
| 155 | Arthritis and spondyloarthropathies | Musculoskeletal | 66.1% | 932 | 305 | 22 |
| 156 | Normal structure and function of the GI tract | Gastroenterology | 66.5% | 1,003 | 306 | 19 |
| 157 | Bleeding disorders | Hematology & Oncology | 68.2% | 352 | 142 | 7 |
| 158 | Normal structure and function of skin | Dermatology | 68.3% | 186 | 92 | 6 |
| 159 | Autoimmune disorders and vasculitides | Musculoskeletal | 69.0% | 1,207 | 411 | 27 |
| 160 | Congenital and developmental anomalies | Neurology | 69.3% | 371 | 126 | 9 |
| 161 | Hypersensitivity responses | Immunology | 70.2% | 859 | 212 | 26 |
| 162 | Congenital and developmental anomalies | Pulmonary & Critical Care | 70.4% | 345 | 136 | 8 |
| 163 | Miscellaneous | Psychiatry | 71.2% | 1,535 | 226 | 36 |
| 164 | Interstitial lung disease | Pulmonary & Critical Care | 71.3% | 696 | 179 | 17 |
| 165 | Demyelinating diseases | Neurology | 72.0% | 200 | 86 | 5 |
| 166 | Congenital and developmental anomalies | Gastroenterology | 73.3% | 1,518 | 484 | 29 |
| 167 | PPV/NPV | Biostatistics & Epidemiology | 73.5% | 151 | 74 | 5 |
| 168 | Personality disorders | Psychiatry | 73.7% | 114 | 64 | 11 |
| 169 | Knee disorders | Musculoskeletal | 73.8% | 267 | 116 | 7 |
| 170 | Breast disorders | Reproductive (Female) | 76.5% | 540 | 153 | 13 |
| 171 | HIV and sexually transmitted infections | Infectious Diseases | 76.7% | 210 | 96 | 6 |
| 172 | Hypothalamus and pituitary disorders | Endocrine, Diabetes & Metabolism | 79.4% | 656 | 374 | 9 |
| 173 | Pulmonary hypertension | Pulmonary & Critical Care | 80.0% | 290 | 119 | 7 |

### Step 1 systems

| System | First-attempt accuracy | First attempts | Students | Topics |
| --- | --- | --- | --- | --- |
| Biostatistics & Epidemiology | 52.9% | 3,690 | 574 | 14 |
| Biochemistry (General Principles) | 53.2% | 5,473 | 769 | 15 |
| Genetics (General Principles) | 54.0% | 2,111 | 459 | 6 |
| Pharmacology (General Principles) | 55.8% | 1,284 | 405 | 4 |
| Cardiovascular System | 56.2% | 19,653 | 1,448 | 20 |
| Poisoning & Environmental Exposure | 56.2% | 361 | 96 | 1 |
| Social Sciences (Ethics/Legal/Professional) | 56.4% | 801 | 321 | 3 |
| Ear, Nose & Throat (ENT) | 56.5% | 568 | 181 | 6 |
| Infectious Diseases | 58.3% | 11,001 | 983 | 8 |
| Neurology | 58.5% | 13,989 | 1,130 | 20 |
| Hematology & Oncology | 58.5% | 9,894 | 998 | 11 |
| Pathology (General Principles) | 58.9% | 1,594 | 491 | 5 |
| Immunology | 59.0% | 7,480 | 777 | 11 |
| Gastroenterology | 59.2% | 14,386 | 1,198 | 12 |
| Endocrine, Diabetes & Metabolism | 59.2% | 13,190 | 1,021 | 12 |
| Pulmonary & Critical Care | 59.6% | 11,966 | 928 | 15 |
| Dermatology | 59.6% | 5,379 | 781 | 9 |
| Renal, Urinary Systems & Electrolytes | 59.9% | 15,046 | 1,096 | 15 |
| Reproductive (Male) | 59.9% | 4,093 | 809 | 6 |
| Psychiatry | 60.0% | 6,098 | 708 | 8 |
| Musculoskeletal | 60.7% | 7,920 | 824 | 17 |
| Ophthalmology | 60.8% | 1,094 | 229 | 7 |
| Reproductive (Female) | 61.5% | 9,806 | 879 | 16 |

## Step 2 CK topics ranked by first-attempt accuracy

| # | Topic | System | First-attempt accuracy | First attempts | Students | Questions |
| --- | --- | --- | --- | --- | --- | --- |
| 1 | Cardiovascular drugs | Cardiovascular System | 47.0% | 198 | 62 | 9 |
| 2 | Transplant medicine | Allergy & Immunology | 47.8% | 184 | 54 | 10 |
| 3 | Chronic kidney disease | Renal, Urinary Systems & Electrolytes | 48.0% | 377 | 80 | 17 |
| 4 | Breast disorders | Female Reproductive System & Breast | 51.3% | 879 | 195 | 32 |
| 5 | Miscellaneous | Hematology & Oncology | 51.7% | 422 | 181 | 21 |
| 6 | Congenital and developmental anomalies | Rheumatology/Orthopedics & Sports | 52.3% | 172 | 61 | 12 |
| 7 | Sleep disorders | Nervous System | 53.2% | 310 | 104 | 13 |
| 8 | Disorders of the male reproductive system | Male Reproductive System | 53.4% | 820 | 187 | 37 |
| 9 | Nephrolithiasis, hematuria, and urinary tract obstruction | Renal, Urinary Systems & Electrolytes | 53.9% | 1,445 | 244 | 58 |
| 10 | Parasitic and helminthic infections | Infectious Diseases | 54.2% | 343 | 77 | 19 |
| 11 | Adrenal disorders | Endocrine, Diabetes & Metabolism | 54.3% | 841 | 208 | 38 |
| 12 | Biliary tract disorders | Gastrointestinal & Nutrition | 54.6% | 855 | 130 | 39 |
| 13 | Arthritis and spondyloarthropathies | Rheumatology/Orthopedics & Sports | 55.4% | 1,221 | 180 | 60 |
| 14 | Miscellaneous | Pulmonary & Critical Care | 55.6% | 117 | 50 | 6 |
| 15 | Hepatic disorders | Gastrointestinal & Nutrition | 55.7% | 1,437 | 203 | 66 |
| 16 | Tumors of the nervous system | Nervous System | 56.0% | 430 | 88 | 21 |
| 17 | Bacterial infections | Infectious Diseases | 56.3% | 2,891 | 277 | 159 |
| 18 | Platelet disorders | Hematology & Oncology | 56.4% | 512 | 95 | 33 |
| 19 | Viral infections | Infectious Diseases | 57.8% | 1,299 | 205 | 65 |
| 20 | Fluid, electrolytes, and acid-base | Renal, Urinary Systems & Electrolytes | 57.9% | 1,200 | 134 | 55 |
| 21 | Pulmonary infections | Pulmonary & Critical Care | 58.3% | 969 | 191 | 43 |
| 22 | Miscellaneous | Endocrine, Diabetes & Metabolism | 58.4% | 464 | 130 | 27 |
| 23 | Miscellaneous | Infectious Diseases | 58.8% | 131 | 61 | 7 |
| 24 | Healthcare policy and economics | Social Sciences (Ethics/Legal/Professional) | 58.9% | 350 | 76 | 17 |
| 25 | Inflammatory dermatoses and bullous diseases | Dermatology | 59.1% | 1,358 | 215 | 77 |
| 26 | Hemostasis and thrombosis | Hematology & Oncology | 59.1% | 345 | 71 | 22 |
| 27 | Intestinal and colorectal disorders | Gastrointestinal & Nutrition | 59.4% | 2,784 | 258 | 110 |
| 28 | Critical care and trauma medicine | Pulmonary & Critical Care | 59.4% | 2,763 | 274 | 126 |
| 29 | Disorders of the ear, nose, and throat | Ear, Nose & Throat (ENT) | 59.5% | 845 | 171 | 33 |
| 30 | Genitourinary tract infections | Female Reproductive System & Breast | 59.5% | 513 | 137 | 21 |
| 31 | Hypertension | Cardiovascular System | 59.8% | 597 | 155 | 22 |
| 32 | CNS infections | Nervous System | 59.8% | 575 | 139 | 24 |
| 33 | Congenital and developmental anomalies | Pulmonary & Critical Care | 59.9% | 202 | 66 | 10 |
| 34 | Reproductive endocrinology | Endocrine, Diabetes & Metabolism | 60.3% | 873 | 169 | 46 |
| 35 | Cardiac arrhythmias and syncope | Cardiovascular System | 60.5% | 2,325 | 291 | 93 |
| 36 | Menstrual disorders and contraception | Female Reproductive System & Breast | 60.8% | 668 | 152 | 29 |
| 37 | Glomerular diseases, nephrotic/nephritic syndrome | Renal, Urinary Systems & Electrolytes | 60.8% | 505 | 98 | 22 |
| 38 | Miscellaneous | Cardiovascular System | 61.0% | 105 | 42 | 6 |
| 39 | Disorders of the eye and associated structures | Ophthalmology | 61.1% | 1,554 | 210 | 80 |
| 40 | Autoimmune diseases | Allergy & Immunology | 61.1% | 175 | 58 | 9 |
| 41 | Disorders of peripheral nerves and muscles | Nervous System | 61.5% | 548 | 89 | 25 |
| 42 | Traumatic brain injuries | Nervous System | 61.6% | 606 | 95 | 29 |
| 43 | Miscellaneous | Gastrointestinal & Nutrition | 61.8% | 803 | 240 | 30 |
| 44 | Acute kidney injury | Renal, Urinary Systems & Electrolytes | 61.9% | 1,615 | 235 | 60 |
| 45 | Aortic and peripheral artery diseases | Cardiovascular System | 62.0% | 1,576 | 220 | 65 |
| 46 | Cerebrovascular disease | Nervous System | 62.0% | 1,387 | 205 | 58 |
| 47 | Heart failure and shock | Cardiovascular System | 62.1% | 1,256 | 206 | 48 |
| 48 | Coronary heart disease | Cardiovascular System | 62.2% | 1,147 | 196 | 45 |
| 49 | Genital tract tumors and tumor-like lesions | Female Reproductive System & Breast | 62.2% | 792 | 218 | 24 |
| 50 | Neoplasms and trauma of the kidneys and urinary tract | Renal, Urinary Systems & Electrolytes | 62.3% | 430 | 78 | 21 |
| 51 | Principles of oncology | Hematology & Oncology | 62.5% | 307 | 151 | 13 |
| 52 | Pulmonary vascular and cardiopulmonary disease | Pulmonary & Critical Care | 62.6% | 811 | 168 | 38 |
| 53 | Pancreatic disorders | Gastrointestinal & Nutrition | 62.7% | 515 | 96 | 25 |
| 54 | Endocrine tumors | Endocrine, Diabetes & Metabolism | 62.7% | 399 | 85 | 22 |
| 55 | Fungal infections | Infectious Diseases | 63.0% | 359 | 124 | 18 |
| 56 | Congenital and developmental anomalies | Gastrointestinal & Nutrition | 63.1% | 564 | 91 | 28 |
| 57 | Psychotic disorders | Psychiatric/Behavioral & Substance Use Disorder | 63.2% | 448 | 78 | 24 |
| 58 | Anaphylaxis and allergic reactions | Allergy & Immunology | 63.3% | 1,056 | 188 | 44 |
| 59 | Headache | Nervous System | 63.3% | 425 | 83 | 18 |
| 60 | Thyroid disorders | Endocrine, Diabetes & Metabolism | 63.6% | 1,057 | 129 | 57 |
| 61 | Gastroesophageal disorders | Gastrointestinal & Nutrition | 63.7% | 1,022 | 184 | 44 |
| 62 | Seizures and epilepsy | Nervous System | 63.7% | 573 | 142 | 25 |
| 63 | Patient safety | Social Sciences (Ethics/Legal/Professional) | 63.7% | 204 | 111 | 9 |
| 64 | Disorders of pregnancy, childbirth, and puerperium | Pregnancy, Childbirth & Puerperium | 63.9% | 4,548 | 241 | 232 |
| 65 | Bone, joint, and soft tissue injuries and infections | Rheumatology/Orthopedics & Sports | 63.9% | 2,554 | 281 | 133 |
| 66 | Mood disorders | Psychiatric/Behavioral & Substance Use Disorder | 63.9% | 1,003 | 159 | 47 |
| 67 | Red blood cell disorders | Hematology & Oncology | 64.1% | 1,364 | 188 | 74 |
| 68 | Cancer and pulmonary/mediastinal masses | Pulmonary & Critical Care | 64.1% | 647 | 111 | 33 |
| 69 | Transfusion medicine | Hematology & Oncology | 64.5% | 200 | 69 | 11 |
| 70 | HIV and sexually transmitted infections | Infectious Diseases | 64.6% | 1,086 | 201 | 52 |
| 71 | Diabetes mellitus | Endocrine, Diabetes & Metabolism | 64.7% | 1,335 | 218 | 64 |
| 72 | Disorders of nutrition | Gastrointestinal & Nutrition | 64.7% | 626 | 105 | 29 |
| 73 | Immune deficiencies | Allergy & Immunology | 64.9% | 171 | 45 | 8 |
| 74 | Myopericardial diseases | Cardiovascular System | 65.3% | 553 | 162 | 23 |
| 75 | Miscellaneous | Nervous System | 65.4% | 1,194 | 198 | 55 |
| 76 | Valvular heart diseases | Cardiovascular System | 65.7% | 991 | 145 | 45 |
| 77 | White blood cell disorders | Hematology & Oncology | 65.7% | 597 | 107 | 40 |
| 78 | Environmental exposure | Poisoning & Environmental Exposure | 65.7% | 248 | 62 | 15 |
| 79 | Interstitial pulmonary and other systemic disorders | Pulmonary & Critical Care | 65.8% | 240 | 62 | 14 |
| 80 | Autoimmune disorders and vasculitides | Rheumatology/Orthopedics & Sports | 66.2% | 1,262 | 226 | 63 |
| 81 | Miscellaneous | Female Reproductive System & Breast | 66.4% | 798 | 146 | 32 |
| 82 | Normal pregnancy, childbirth, and puerperium | Pregnancy, Childbirth & Puerperium | 66.4% | 586 | 100 | 29 |
| 83 | Congenital and developmental anomalies | Endocrine, Diabetes & Metabolism | 66.9% | 160 | 52 | 9 |
| 84 | Metabolic bone disorders | Rheumatology/Orthopedics & Sports | 66.9% | 148 | 51 | 8 |
| 85 | Hydrocephalus | Nervous System | 67.3% | 202 | 65 | 9 |
| 86 | Epidemiology and population health | Biostatistics & Epidemiology | 67.5% | 203 | 107 | 6 |
| 87 | Plasma cell disorders | Hematology & Oncology | 67.8% | 273 | 112 | 14 |
| 88 | Somatoform disorders and sleep disorders | Psychiatric/Behavioral & Substance Use Disorder | 67.9% | 763 | 147 | 35 |
| 89 | Substance use disorders | Psychiatric/Behavioral & Substance Use Disorder | 67.9% | 676 | 174 | 29 |
| 90 | Obesity and dyslipidemia | Endocrine, Diabetes & Metabolism | 68.1% | 589 | 193 | 25 |
| 91 | Anxiety and trauma-related disorders | Psychiatric/Behavioral & Substance Use Disorder | 68.7% | 968 | 110 | 48 |
| 92 | Toxicology | Poisoning & Environmental Exposure | 69.1% | 904 | 108 | 60 |
| 93 | Obstructive and restrictive lung disease | Pulmonary & Critical Care | 69.4% | 1,407 | 220 | 60 |
| 94 | Spinal cord disorders | Nervous System | 69.4% | 638 | 103 | 31 |
| 95 | Skin tumors and tumor-like lesions | Dermatology | 69.7% | 778 | 95 | 52 |
| 96 | Neurodegenerative disorders and dementias | Nervous System | 69.8% | 945 | 161 | 38 |
| 97 | Study design and interpretation | Biostatistics & Epidemiology | 69.8% | 785 | 160 | 17 |
| 98 | Skin and soft tissue infections | Dermatology | 70.0% | 607 | 105 | 36 |
| 99 | Miscellaneous | Rheumatology/Orthopedics & Sports | 70.6% | 170 | 45 | 10 |
| 100 | Demyelinating diseases | Nervous System | 70.7% | 362 | 161 | 11 |
| 101 | Tumors of the GI tract | Gastrointestinal & Nutrition | 70.8% | 524 | 107 | 23 |
| 102 | Hypothalamus and pituitary disorders | Endocrine, Diabetes & Metabolism | 71.7% | 520 | 105 | 31 |
| 103 | Congenital heart disease | Cardiovascular System | 71.8% | 614 | 183 | 23 |
| 104 | Personality, impulse control, and sexual disorders | Psychiatric/Behavioral & Substance Use Disorder | 73.0% | 826 | 152 | 34 |
| 105 | Miscellaneous | Dermatology | 73.0% | 282 | 71 | 19 |
| 106 | Sleep disorders | Pulmonary & Critical Care | 73.2% | 220 | 109 | 8 |
| 107 | Diabetes insipidus | Renal, Urinary Systems & Electrolytes | 73.2% | 149 | 52 | 7 |
| 108 | Normal behavior and development | Psychiatric/Behavioral & Substance Use Disorder | 75.1% | 321 | 157 | 12 |
| 109 | Anesthesia/pharmacotherapy | Nervous System | 75.6% | 315 | 86 | 15 |
| 110 | Normal structure and function of the female reproductive system and breast | Female Reproductive System & Breast | 76.3% | 114 | 48 | 6 |
| 111 | Eating disorders | Psychiatric/Behavioral & Substance Use Disorder | 77.5% | 552 | 218 | 12 |
| 112 | Medical ethics and jurisprudence | Social Sciences (Ethics/Legal/Professional) | 77.8% | 2,418 | 245 | 133 |
| 113 | Neurodevelopmental and neurocognitive disorders | Psychiatric/Behavioral & Substance Use Disorder | 78.3% | 382 | 76 | 20 |
| 114 | Congenital and developmental anomalies | Female Reproductive System & Breast | 79.6% | 152 | 54 | 7 |
| 115 | Communication and interpersonal skills | Social Sciences (Ethics/Legal/Professional) | 80.1% | 467 | 84 | 27 |

### Step 2 CK systems

| System | First-attempt accuracy | First attempts | Students | Topics |
| --- | --- | --- | --- | --- |
| Male Reproductive System | 53.4% | 820 | 187 | 1 |
| Infectious Diseases | 58.6% | 6,198 | 335 | 8 |
| Renal, Urinary Systems & Electrolytes | 59.5% | 6,430 | 360 | 9 |
| Ear, Nose & Throat (ENT) | 59.5% | 845 | 171 | 1 |
| Gastrointestinal & Nutrition | 60.5% | 9,136 | 437 | 9 |
| Female Reproductive System & Breast | 61.1% | 3,916 | 307 | 7 |
| Ophthalmology | 61.1% | 1,554 | 210 | 1 |
| Allergy & Immunology | 61.4% | 1,587 | 216 | 5 |
| Hematology & Oncology | 61.8% | 4,028 | 318 | 8 |
| Cardiovascular System | 62.4% | 9,414 | 445 | 10 |
| Pulmonary & Critical Care | 62.5% | 7,376 | 367 | 9 |
| Rheumatology/Orthopedics & Sports | 62.6% | 5,625 | 347 | 8 |
| Endocrine, Diabetes & Metabolism | 63.0% | 6,332 | 364 | 10 |
| Nervous System | 64.1% | 8,553 | 382 | 15 |
| Pregnancy, Childbirth & Puerperium | 64.2% | 5,134 | 251 | 2 |
| Dermatology | 65.3% | 3,094 | 263 | 5 |
| Poisoning & Environmental Exposure | 68.4% | 1,152 | 122 | 2 |
| Biostatistics & Epidemiology | 68.6% | 1,042 | 172 | 3 |
| Psychiatric/Behavioral & Substance Use Disorder | 69.8% | 6,035 | 343 | 10 |
| Social Sciences (Ethics/Legal/Professional) | 74.8% | 3,515 | 271 | 6 |

## Method

- **Metric.** First-attempt accuracy: for each student and question, only the earliest attempt inside the window is counted. Repeat attempts are excluded.
- **Window.** Attempts from the last 180 days. A student who first saw a question before the window counts as a first attempt here if they answered it again inside it.
- **Population.** StepGenie users answering in the web and mobile question bank, including questions served inside self-assessment blocks. There is no column that separates self-assessment attempts, so they are in.
- **Excluded.** Question-of-the-day attempts, internal and test accounts, and Step 3.
- **Step 3.** Left out because its questions are largely derived from Step 2 items, so the two rankings would not be independent, and because the volume is thin: 2,291 first attempts from 124 students in the window, with 2 topics clearing the floor.
- **Grouping.** Grouped by system_topics.id and systems.id, not by name -- topic names such as 'Miscellaneous' repeat across systems.
- **Not the same as the site-wide figure.** This is not the same figure as platform-stats.json overallAccuracyPct, which averages every attempt including repeats.
- **Publication floor.** At least 100 first attempts, 20 distinct students and 5 distinct questions per topic.
- **Reproducing it.** `packages/db/scripts/most-missed-topics.ts` writes the JSON this page renders. Nothing is aggregated at request time, and no individual student, account or answer is published.

## What this report does not tell you

- These are StepGenie questions, not NBME items; their difficulty is not calibrated against the real exam.
- The population is self-selected -- students choose what to practise, so a low score partly reflects who attempts a topic.
- Topic sizes are uneven; the first-attempt and student counts on every row show the weight behind each percentage.
- One window is published here. Nothing on this page tracks change over time.

## Links

- [Full report](https://www.stepgenie.app/reports/most-missed-usmle-topics)
- [Topic hubs](https://www.stepgenie.app/topics)
- [Blog -- USMLE prep articles and study strategies](https://www.stepgenie.app/blog)